Experiencia en reconstrucción del paciente gran quemado agudo con microcirugía

Introducción: Las quemaduras son un trauma frecuente de ocurrencia en todo el mundo, que ha experimentado importantes aumentos de sobrevida. Su manejo requiere la reposición de la barrera cutánea, lo que se logra en la mayoría de los casos con el uso de injertos dermo-epidérmicos. Sin embargo, existen algunas veces lesiones complejas que no logran sanar mediante injertos, arriesgando la funcionalidad o vitalidad del área comprometida, que requerirán reparaciones complejas con el uso de colgajos microqui- rúrgicos (CM). Metodología: Estudio descriptivo retrospectivo en que incluimos todos los pacientes gran quemados agudos admitidos en Hospital de Urgencia de la Asistencia Pública, Servicio de Quemados y Rehabilitación, desde abril de 2019 hasta diciembre de 2020 los que fueron manejados con colgajo micro- quirúrgico. Revisión de ficha clínica para obtención de variables demográficas y del procedimiento con análisis de frecuencia de ocurrencia. Resultados: En nuestro período de estudio hubo 376 ingresos y 21 pacientes recibieron 25 CM. La mayoría hombres (96%), edad promedio 40 años, superficie comprometida promedio 16%, mecanismo más frecuente electricidad (64%) y fuego (32%). La ubicación más frecuente del colgajo fue en extremidades inferiores (64%) y el colgajo más utilizado fue el anterolateral de muslo (80%). Tiempo medio a reconstrucción fueron 40 días, no hubo pérdida total del colgajo. Discusión: se realizó un CM en 5,6% de nuestros ingresos, la mayoría durante el intervalo primario tardío, sin pérdidas totales. Estos resultados representan la consolidación de la técnica que permite su uso en el paciente gran quemado durante su etapa aguda, permitiendo coberturas complejas y manteniendo riesgo quirúrgico y tasa de complicaciones adecuada con enfoque en rehabilitación precoz.

Introduction: Burns are the fourth most common trauma. Microsurgery has evolved as a valuable tool in the acute setting allowing early closure of complex wounds in order to avoid infection, maintain function or even for limb salvage in one stage reconstruction. We present our experience at our burn center in Chile. Method: We performed a retrospective analysis of all major burn patients admitted in the National Burn Center in Chile who received a microsurgical flap in the period between April 2019 to December 2020. Results: A total of 21 patients had 25 free flaps. All patients but one were male (96%), mean age 40 years (range 20-69 years). Total body surface area means 16% (range 1-64%). Most of the injuries were caused by high voltage electricity (64%) and fire (32%). 64% were performed in lower limbs and 36% in upper limbs. In 80% of the cases, anterolateral thing flap was chosen. Mean time to reconstruction was 40 days. We didn't experience a total flap lost in this series. Discussion: In the acute phase microsurgery proved to be safe and feasible albeit a small surgical indication. We performed a flap in 5.6% of our admissions, mostly during late primary interval with no flaps lost. Our results acknowledge the consolidation of the technique for its use in the acutely burned setting, allowing complex coverage while maintaining the surgical risk and an internationally acceptable rate of losses and complications.

Autologous platelet-rich plasma treatment for infected deep second-degree burn wounds: a case report / 中国输血杂志

【Objective】 To explore the feasibility of using autologous platelet-rich plasma (PRP) in the treatment of deep second-degree burns complicated with wound infection. 【Methods】 A retrospective analysis was conducted on the treatment process of a patient with deep second-degree burns and bacterial infection on the wound using autologous PRP. Clinical treatment highlights and outpatient follow-up were combined to discuss the feasibility and clinical effects of using autologous PRP in the treatment of burn wounds complicated with infection. 【Results】 The patient had a deep second-degree burn with a coagulase-negative Staphylococcus infection on the left lower limb. After one week of conventional wound dressing and antibiotic treatment, the patient's body temperature returned to normal. However, wound healing was slow and yellow secretion persisted. Subsequently, the burn wound was treated combined with topical autologous PRP. The wound pain score gradually decreased from 8 to 1. After 2 weeks, the bacterial culture of the wound secretion was negative, and the wound healed completely after 18 days. The wound scar score decreased from 5 to 2 at 1, 3 and 6 months after PRP treatment, and no obvious scar formation was observed. In the course of PRP treatment, there were no adverse reactions such as increased wound inflammation, abnormal blood routine and liver and kidney function test results. 【Conclusion】 For deep second-degree burn patients with localized wound bacterial infections who either refuse surgery or are not suitable for surgery, autologous PRP is a safer alternative that can effectively promote tissue regeneration and wound healing. The patient in this case achieved a curative effect in a short period of time.

Research progress of metabolomics in the diagnosis and treatment of severe injuries / 基础医学与临床

Metabolomics is a novel emerging technology recently applied in management of severe diseases and trauma,and has been widely used in gene analysis of disease metabolic disorders,clinical biomarker screening and disease diagnosis.This review comprehensively summarizes the latest research progress of the metabolomics in severe trauma and burns recently like traumatic brain injury(TBI),traumatic hemorrhagic shock,severe burns and so on.The paper elaborates the metabolomic technology which can quickly reflect the real-time metabolic changes of severely injured patients at different stages after injury,and uncovers new clinical biomarkers and potential drug targets of the patients with severe injuries thus improves the diagnosis and treatment strategies.Finally,we look for-ward to the current metabolomics research projects and tackling challenges on the burn-blast combined injuries,and the simultaneous development of multi-omics technology as well as artificial intelligence algorithms,which promotes the development of precision medicine.

Liposome gel loaded oleic acid promotes the repair of chronic burn wounds / 中国组织工程研究

BACKGROUND:Oleic acid can regulate inflammation and immune responses,and has the potential to repair skin wounds.Oleic acid has a short retention time at the lesion.It is prone to self oxidation and deterioration in the air,and suitable drug carriers are needed to fully exert the therapeutic effect of oleic acid. OBJECTIVE:To investigate the efficacy of oleic acid-liposome gel in the treatment of chronic burn wounds. METHODS:Oleic acid liposome solution was prepared by thin film dispersion method,and then dissolved in Poloxamer gel matrix to prepare oleic acid-liposome gel.(1)In vitro experiment:Oleic acid-liposome gel solution was prepared by adding different volumes of oleic acid-liposome gel into cell medium(volume ratio:1:3,1:9,1:27,respectively).Alma-blue reagent was used to detect the effects of different concentrations of oleic acid-liposome gel on the proliferation of human keratinocytes and human fibroblasts.Crystal violet staining was used to observe cell morphology.(2)In vivo experiment:The animal model of chronic burn wounds was established by using full-thickness burn of SD rat back skin combined with local subcutaneous injection of epirubicin.The 30 successfully modeled rats were randomly divided into five groups with six rats in each group.The wounds of oleic acid liposome gel group,oleic acid group,liposome gel group,positive control group and negative control group were applied with gauze of oleic acid liposome gel,oleic acid,liposome gel,recombinant human epidermal growth factor gel and normal saline.The dressing was changed once every other day.A total of 16 doses were administered.The wound healing was observed. RESULTS AND CONCLUSION:(1)In vitro experiments:Alma-blue reagent detection and crystal violet staining showed that oleic acid liposome gel solution with volume ratio of 1:9 could promote the proliferation of human keratinocytes and human fibroblasts.(2)In vivo experiment:The wound healing time of the oleic acid liposome gel group was shorter than that of the other four groups(P＜0.01),and the wound healing rate at 4,8,12,16,and 20 days was higher than that of the other four groups(P＜0.01).After administration,hematoxylin-eosin staining showed epithelialization and healing of wounds in all five groups,and the epidermal thickness of oleic acid liposome gel group was the closest to normal skin and better than the other four groups.Immunohistochemical staining showed that the expressions of cytokeratin 10,tumor protein 63,α-smooth muscle actin,collagen I,tumor necrosis factor α,interleukin 6,malonaldehyde,and superoxide dismutase in oleic acid liposome gel group were closest to those in normal skin,and superior to those in other four groups.On days 12 and 32 of administration,the expressions of tumor necrosis factor α,interleukin 6,malondialdehyde,and superoxide dismutase in wound homogenate supernatant in oleic acid liposome gel group were closest to those in normal skin,and superior to those in other four groups.(3)The results showed that oleic acid liposome gel could promote the proliferation of keratinocytes and fibroblasts,reduce inflammation and oxidative stress injury,and promote the healing of chronic burn wounds.

Rehabilitation of geriatric burn patient post-meek micrograft with bilateral partial calcanectomy: A case report

@#Looking along the physiological and physical changes in aging, in the light of a major burn, co-morbidities, surgical intervention and precaution, a geriatric burn patient requires a delicate balance of ideal burn care and rehabilitation to achieve functional independence. A 70-year-old patient, with 30% total body surface area flame burn injury, underwent bilateral partial calcanectomy secondary to calcaneus osteomyelitis, and Meek micrograft technique for burn injury on bilateral lower extremities, is presented in this case report. In order to ensure good graft take, her knees were immobilized causing bilateral soft tissue contractures. Subsequently, upon initiation of ambulation, gait abnormalities observed include absence of heel off and toe off, with heel walking. The patient was admitted for intensive inpatient rehabilitation, where significant improvement in the knee range of motion and ambulation were achieved. The patient was eventually discharged ambulatory with walker. Despite expected complications, rehabilitation management proved to be beneficial in improving function and ambulation in geriatric burn patient.

Case report of dental intervention in intensive care unit in patient with face burns / Relato de caso de intervenção odontológica em unidade de terapia intensiva em paciente com queimadura de face

ABSTRACT Burns are identified as a trauma that has a high degree of mortality and disability, both functionally and aesthetically. In the head and neck region, burn injuries can evolve mainly due to hypertrophic scars and contractures This study aimed to observe the progression and outcome of healing in face burns with the use of a low-power laser and oral splint. A descriptive and observational study was carried out, which corresponds to the case report of a severely burned patient with burns in the orofacial region. Early odontologic treatment care during hospitalization is essential to reduce hypertrophic scars and contractures in a severely burned patient with burns in the orofacial region.

RESUMO As queimaduras são identificadas como um trauma que possui alto grau de mortalidade e incapacidade, tanto no aspecto funcional quanto na estética. Em região de cabeça e pescoço, as lesões por queimadura podem evoluir principalmente com cicatrizes hipertróficas e contraturas. O Objetivo foi avaliar a progressão e o desfecho do reparo tecidual em queimadura de face com o uso do laser de baixa potência e splint oral. Trata-se de um estudo observacional descritivo, que corresponde ao relato de caso de um paciente grande queimado. A intervenção odontológica é fundamental para que se diminua cicatrizes hipertróficas e contraturas, restabelecendo da melhor forma possível a função do sistema estomatognático.

Intubación orotraqueal en el trauma por quemaduras en Uruguay: rol de la intubación profiláctica

Introducción: La Intubación orotraqueal (IOT) profiláctica en pacientes con sospecha de Injuria Inhalatoria (II) es una práctica clínica extendida en nuestro país. La misma puede estar asociada a complicaciones y a un aumento de los costos asistenciales. Objetivo: caracterizar a la población de pacientes que ingresaron con IOT al Centro Nacional de Quemados, determinar la incidencia de Intubación orotraqueal no necesaria (IOTNN) así como las complicaciones vinculadas a la misma. Método: Estudio retrospectivo, observacional, analítico. Se incluyeron todos los pacientes con quemadura térmica ingresados al CENAQUE con vía aérea artificial entre enero de 2015 y julio 2023. Se determinaron características demográficas, circunstancias de la injuria, lugar y técnico que realizo la IOT, porcentaje de superficie corporal total quemada (SCTQ), scores de severidad, días de ARM, estado al alta y diagnóstico de II por fibrobroncoscopía. Se analizaron las complicaciones asociadas a la IOT y ARM. Dichas variables fueron contrastadas entre el grupo extubado exitosamente en las primeras 48 horas (IOTNN) y aquellos extubados luego de las 48 horas (IOTP). Resultados: Se incluyeron 562 pacientes. La incidencia de IOTNN fue 41,7% e II 46,7%. Se observaron diferencias significativas entre IOTNN y IOTP para edad [34 (24-48) versus 45 (30-62); p <0,001, para SCTQ [4% (1-11) versus 20% (6-36); p <0,001], ABSI [4 (3-5) versus 7 (5-9) p<0,001], Rev. Baux [48 (33-62) versus 77 (60-99), p <0,001], incidencia de II (32% versus 56,6%, p <0,001). La aspiración de VA (30% versus 20,2% p 0,018), extubación durante el traslado (2% versus 0% p 0,043) e incidencia de NA (Neumonía aspirativa) y NAVP (neumonía asociada a la ventilación mecánica precoz) (56,3% versus 15% p <0,001) fueron mayores en el grupo IOTP. Conclusiones: La IOTNN en los pacientes con quemaduras es frecuente en nuestro medio y se asocia a complicaciones. La misma es realizada por médicos sin formación en el manejo de la vía aérea.

Introduction: Prophylactic Orotracheal Intubation (OTI) in patients with suspected Inhalation Injury (II) is a widespread clinical practice in our country. It can be associated with complications and increased healthcare costs. Objective: To characterize the population of patients admitted with OTI to the National Burn Center, determine the incidence of unnecessary Orotracheal Intubation (UOTI), and the associated complications. Method: Retrospective, observational, analytical study. All patients with thermal burns admitted to the National Burn Center (CENAQUE) with an artificial airway between January 2015 and July 2023 were included. Demographic characteristics, injury circumstances, location, and technician performing the OTI, percentage of total body surface area burned (TBSA), severity scores, days on mechanical ventilation, discharge status, and diagnosis of II by fibrobronchoscopy were determined. Complications associated with OTI and mechanical ventilation were analyzed. These variables were compared between the group extubated successfully within the first 48 hours (UOTI) and those extubated after 48 hours (necessary OTI, NOTI). Results: 562 patients were included. The incidence of UOTI was 41,7% and II 46,7%. Significant differences were observed between UOTI and NOTI in age [34 (24-48) versus 45 (30-62); p <0.001], TBSA [4% (1-11) versus 20% (6-36); p <0,001], ABSI [4 (3-5) versus 7 (5-9) p<0,001], Baux score [48 (33-62) versus 77 (60-99), p <0,001], incidence of II (32% versus 56.6%, p <0,001). Aspiration of the airway (30% versus 20,2% p 0,018), extubation during transport (2% versus 0% p 0,043), and incidence of aspiration pneumonia (AP) and early ventilator-associated pneumonia (VAP) (56,3% versus 15% p <0,001) were higher in the NOTI group. Conclusions: UOTI in burn patients is frequent in our setting and is associated with complications. It is performed by physicians without training in airway management.

Introdução: A intubação orotraqueal (IOT) profilática em pacientes com suspeita de lesão por inalação (LI) é uma prática clínica difundida em nosso país. Esta prática pode estar associada a complicações e ao aumento dos custos assistenciais. Objetivo: Caracterizar a população de pacientes que ingressaram com IOT no Centro Nacional de Queimados, determinar a incidência de intubação orotraqueal desnecessária (IOTD) e as complicações associadas. Método: Estudo retrospectivo, observacional, analítico. Foram incluídos todos os pacientes com queimadura térmica admitidos no CENAQUE com via aérea artificial entre janeiro de 2015 e julho de 2023. Foram determinadas características demográficas, circunstâncias da lesão, local e técnico que realizou a IOT, porcentagem da superfície corporal total queimada (SCTQ), escores de gravidade, dias de ventilação mecânica, estado na alta e diagnóstico de LI por fibrobroncoscopia. Complicações associadas à IOT e à ventilação mecânica foram analisadas. Essas variáveis foram comparadas entre o grupo extubado com sucesso nas primeiras 48 horas (IOTD) e aqueles extubados após 48 horas (IOTP). Resultados: Foram incluídos 562 pacientes. A incidência de IOTD foi de 41,7% e LI de 46,7%. Diferenças significativas foram observadas entre IOTD e IOTP em relação à idade [34 (24-48) versus 45 (30-62); p <0,001], SCTQ [4% (1-11) versus 20% (6-36); p <0,001], ABSI [4 (3-5) versus 7 (5-9) p<0,001], índice de Baux [48 (33-62) versus 77 (60-99), p <0,001], incidência de LI (32% versus 56,6%, p <0,001). A aspiração de via aérea (30% versus 20,2% p 0,018), extubação durante o transporte (2% versus 0% p 0,043) e incidência de pneumonia aspirativa (PA) e pneumonia associada à ventilação mecânica precoce (NAVM) (56,3% versus 15% p <0,001) foram maiores no grupo IOTP. Conclusões: A IOTD em pacientes com queimaduras é frequente em nosso meio e está associada a complicações. A mesma é realizada por médicos sem formação no manejo da via aérea.

Effectiveness of Resiliency and Recovery Program on Compassion Fatigue among Nursing Officers working in selected Hospitals in India / Efectividad del Programa de Resiliencia y Recuperación sobre la Fatiga por Compasión entre los profesionales de Enfermería que trabajan en Hospitales seleccionados de la India / Eficácia do Programa de Resiliência e Recuperação na Fadiga por Compaixão entre Profissionais de Enfermagem que Trabalham em Hospitais Selecionados na Índia

Objective. The study objective was to evaluate the effectiveness of Resiliency and Recovery Program on Compassion Fatigue level of Nursing Officer from selected hospitals of Pune City (India). Methods. The study used a quasi-experimental approach involving single group pre-test and post-test design. 100 nursing officers, working in selected hospitals of Pune city, who were willing to participate were selected using non probability convenience sampling. The data was collected using The Professional Quality of Life Scale: Compassion Satisfaction and Fatigue (ProQoL) Version 5 of Stamm. The study included pre-test, resiliency and recovery program and post-test. Resiliency and Recovery Program is an intervention aiming to develop five resiliency skills or antibodies including (a) self-regulation, (b) perceptual maturation, (c) intentionality, (d) self-care and (e) connection and support. Results. Statistically significant difference was revealed between the pre-test and post-test score means: Compassion Satisfaction (pre-test = 28.50 to post-test = 31.0; t-18.6671, p<0.001), Burn-out (pre-test = 35.2 to post-test = 31.7; t-15.00, p<0.001), and Secondary Traumatic Stress (pre-test = 37.4 to post-test = 33.07; t-14.8996, p<0.001). Conclusion. Resiliency and Recovery Program had a significant impact on Compassion Fatigue, leading to an increase in Compassion Satisfaction, and a reduction in Burnout and Secondary Traumatic Stress. Inculcating Resiliency skills in nursing officers can help them in reducing compassion fatigue and thus aids in health promotion.

Objetivo. El objetivo del estudio era evaluar la eficacia del Programa de Resiliencia y Recuperación en el nivel de Fatiga por Compasión de los profesionales de enfermería de los hospitales seleccionados de la ciudad de Pune (India). Métodos. El estudio cuasi-experimental con evaluación pre y post-intervención en un solo grupo. Se seleccionaron 100 profesionales de enfermería que trabajaban en hospitales seleccionados de la ciudad de Pune mediante un muestreo no probabilístico por conveniencia. Los datos se recogieron utilizando la Escala de calidad de vida profesional: Compassion Satisfaction and Fatigue ((ProQOL) Version 5 de Stamm. El estudio incluyó una prueba previa, un programa de resiliencia y recuperación y una prueba posterior. El Programa de Resiliencia y Recuperación es una intervención cuyo objetivo es desarrollar cinco habilidades o anticuerpos de resiliencia que incluyen (a) autorregulación, (b) maduración perceptiva, (c) intencionalidad, (d) autocuidado y (e) conexión y apoyo. Resultados. Se observaron diferencias estadísticamente significativas entre las puntuaciones promedio obtenidas antes y después de la intervención en la satisfacción con la compasión (antes = 28.5 a después = 31; t-18.6671, p<0.0001), el agotamiento (antes = 35.2 a después = a 31.7; t-15,00, p<0.001) y el estrés traumático secundario (antes = 37.4 a después 33.1; t-14.8996, p<0.001). Conclusiones. El Programa de Resiliencia y Recuperación tuvo un impacto significativo en la Fatiga por Compasión, lo que condujo a un aumento de la Satisfacción por Compasión y a una reducción del Burnout y del Estrés Traumático Secundario. Inculcar habilidades de resiliencia a los profesionales de enfermería puede ayudarles a reducir la fatiga por compasión y, por tanto, a promover la salud.

Objetivo. O objetivo do estudo foi avaliar a eficácia do Programa de Resiliência e Recuperação no nível de Fadiga por Compaixão em profissionais de enfermagem em hospitais selecionados na cidade de Pune (Índia). Métodos. Foi realizado um estudo quase experimental com avaliação pré e pós-intervenção em grupo único. Foram selecionados 100 profissionais de enfermagem que trabalham em hospitais da cidade de Pune por meio de amostragem não probabilística de conveniência. Os dados foram coletados por meio da versão 5 da Escala de Qualidade de Vida Profissional: Compaixão, Satisfação e Fadiga (ProQoL) de Stamm. O estudo incluiu um pré-teste, um programa de resiliência e recuperação e um pós-teste. O Programa de Resiliência e Recuperação consistiu em uma intervenção cujo objetivo é desenvolver cinco habilidades de resiliência ou anticorpos que incluem (a) autorregulação, (b) maturação perceptual, (c) intencionalidade, (d) autocuidado e (e) conexão e suporte. Resultados. Foram observadas diferenças estatisticamente significativas entre as pontuações médias obtidas antes e depois da intervenção em satisfação por compaixão (antes = 28.5 a depois = 31; t-18.6671, p<0.0001), burnout (antes = 35.2 a depois = a 31.7; t-15.00), p<0.001) e estresse traumático secundário (antes = 37,4 a depois 33.1; t-14.8996, p<0.001). Conclusões. O Programa de Resiliência e Recuperação teve um impacto significativo na Fadiga por Compaixão, levando a um aumento na Satisfação por Compaixão e a uma redução no Burnout e no Estresse Traumático Secundário. Incutir competências de resiliência nos enfermeiros pode ajudá-los a reduzir a fadiga da compaixão e, portanto, promover a saúde.

Queimaduras e COVID-19, qual o impacto da pandemia? Perfil epidemiológico de um centro de queimados entre 2018-2022 / Burns and COVID-19, what is the impact of the pandemic? Epidemiological profile of a burn center between 2018-2022

Introdução: Embora prevalente, a epidemiologia das queimaduras possui lacunas. Simultaneamente, a COVID-19 estabeleceu um cenário desafiador e com novos comportamentos humanos, que poderiam impactar nas características e na incidência de queimaduras. O objetivo geral do projeto foi descrever o perfil epidemiológico dos pacientes de uma Unidade de Tratamento de Queimados. Método: O estudo foi uma revisão prontuários de janeiro de 2018 até maio de 2022, incluindo uma amostra de 1164 admissões do Hospital Padre Albino (Catanduva-SP). A análise estatística foi realizada através do Google Sheets e JAMOVI, sendo aplicado o Teste U de Mann-Whitney para comparação de períodos de tempo antes e durante a pandemia. Antes da coleta de dados, o mesmo foi submetido e aprovado pelo Conselho de Ética em Pesquisa da instituição (parecer número 5.616.556, CAAE: 62621822.50000.5430). Resultados: As admissões apresentaram idade média de 31,38 anos e 17,88% de Superfície Corporal Queimada (SCQ), sendo 452 mulheres e 712 homens; a média de SCQ foi de 17 para mulheres e 18,6 para homens. O principal agente causador foi a escaldadura. No que tange à comparação por períodos, durante a pandemia a chama direta teve um aumento de 8% em relação ao período anterior (35%). A escaldadura ainda permaneceu com prevalência elevada, no entanto, apresentou queda de 2%, assim como as queimaduras por dermoabrasão, com queda de 10%. Conclusão: Os achados dos estudos possuem limites em termos de generalização e novos estudos precisam ser desenvolvidos. As mudanças observadas no período não foram significativas e sem relevância clínica.

Introduction: Although prevalent, the epidemiology of burns has gaps. At the same time, Covid-19 established a new scenario with new human behaviors, which could equally impact the characteristics and incidence of burns. The overall objective of the project was to describe the epidemiological profile of patients in a Burn Treatment Unit. Methods: The study was a chart review from January 2018 to May 2022, including a sample of 1164 admissions from Hospital Padre Albino (Catanduva, São Paulo, Brazil). Statistical analysis was performed using Google Sheets and JAMOVI, and Mann-Whitney U-test was applied for comparison of time periods before and during the pandemic. Before data collection, the study was submitted and approved by the Research Ethics Committee of the institution (document number 5.616.556, CAAE: 62621822.50000.5430). Results: The admissions presented a mean age of 31.38 years and 17.88% of body surface area burned, 452 women and 712 men, the mean age was 17 for women and 18.6 for men. The main agent was scalding. When it comes to period comparison, during the pandemic direct flaming had an 8% increase over the previous period (35%). The scalds still remained with high prevalence, however it presented a decrease of 2%, as well as the burns by dermabrasion, which had a decrease of 10%. Conclusion: The findings of the studies have limits in terms of generalization, and new studies need to be developed. The changes observed in the period were not significant and without clinical relevance.

Queimadura elétrica: Análise epidemiológica dos pacientes da Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia / Electrical burns: Epidemiological analysis of patients at the Burns Unit of the Hospital de Clínicas of the Federal University of Uberlândia

Introdução: O uso da corrente elétrica é imprescindível nas nossas atividades do cotidiano, porém, seu contato com tecidos vivos pode provocar queimaduras desde leves até graves ou fatais. Por se tratar de um problema de saúde pública, o conhecimento de sua epidemiologia é essencial para o desenvolvimento de programas em saúde. Método: Estudo transversal de dados registrados nos prontuários dos pacientes atendidos por queimadura elétrica na Unidade de Queimados do Hospital de Clínicas da Universidade Federal de Uberlândia entre os anos de 2013 e 2019. Resultados: Foram admitidos 26 pacientes, a maioria de sexo masculino (76,9%) e adultos (30,7%), vítimas de corrente de alta voltagem (65,4%) no trabalho (57,7%), que mais afetou as extremidades superiores (80,7%), sendo as crianças todas do sexo feminino (15,3%). O percentual médio de área queimada foi de 14,5% e o percentual de tratados com autoenxerto de pele foi de 53,8%. A média de permanência hospitalar foi de 40 dias e 3,8% deles foram para a Unidade de Terapia Intensiva. Não se registraram óbitos durante o período. Conclusão: A incidência de pacientes atendidos por queimadura elétrica é baixa, acometendo vítimas em todas as faixas etárias e com predomínio em indivíduos adultos do sexo masculino em seu local de trabalho. O tratamento cirúrgico mais realizado foi o autoenxerto de pele. As políticas de promoção, prevenção e proteção em saúde no que diz respeito aos perigos da corrente elétricas não estariam sendo praticadas e difundidas em nossa população doméstica, laboral ou empregadora, diferentemente como ocorre em grande parte dos países desenvolvidos.

Introduction: Using electric current is essential in our daily activities; however, its contact with living tissue can cause mild to severe or fatal burns. As it is a public health problem, knowledge of its epidemiology is essential for the development of health programs. Method: Cross-sectional study of data recorded in the medical records of patients treated for electrical burns at the Burns Unit of the Hospital de Clínicas of the Universidade Federal de Uberlândia between 2013 and 2019. Results: 26 patients were admitted, the majority of whom were male (76 .9%) and adults (30.7%), victims of high voltage current (65.4%) at work (57.7%), which most affected the upper extremities (80.7%), with children all female (15.3%). The average percentage of burned area was 14. 5% and the % of those treated with skin autograft was 53.8%. The average hospital stay was 40 days, and 3.8% went to the Intensive Care Unit. No deaths were recorded during the period. Conclusion: The incidence of patients treated for electrical burns is low, affecting victims in all age groups and with a predominance of adult males in their workplace. The most common surgical treatment was skin autograft. Health promotion, prevention, and protection policies regarding the dangers of electrical currents would not be practiced and disseminated among our domestic, working, or employing population, unlike what occurs in most developed countries.

Domestic burns that occurred during the COVID-19 pandemic in Brazil: a descriptive cross-sectional study

Abstract BACKGROUND: Due to "stay at home" restrictions during the coronavirus disease 2019 (COVID-19) pandemic, people spent more time at home leading to an increase in home accidents, including burns. OBJECTIVE: To investigate the epidemiology of burns that occurred within homes during the COVID-19 pandemic in Brazil. DESIGN AND SETTINGS: This was a quantitative, descriptive, and cross-sectional study with a non-probabilistic sample. METHODS: Data were collected through the distribution of survey links on social networking sites and websites, and through email between December 2020 and February 2021. Participants were over 18 years of age, living in Brazil. Data analysis was performed using descriptive and dispersion statistics. RESULTS: A total of 939 adults (aged > 18 years) participated in this study. The mean age was 37.2 years (standard deviation [SD] = 12.5), 75.6% were female, 70.0% self-reported white skin color, 74% had completed higher education, and 28.1% had an income of 3 to 6 times the monthly minimum wage. A total of 21.6% suffered burns during the pandemic, 44.3% from a hot object. Approximately 49.3% never had access to a burn prevention campaign. CONCLUSION: It is necessary to develop burn prevention strategies that reach a wider population and to strengthen public policies to reduce the prevalence of domestic burns, especially during the pandemic.

Características clínico Epidemiológicas de los pacientes con quemaduras antes y durante la pandemia por Covid-19 en el Instituto Nacional de Salud del Niño San Borja

Objetivo : Comparar las características clínicoepidemiológicas de pacientes pediátricos con quemaduras antes y durante la pandemia por COVID-19, en el Instituto Nacional de Salud del Niño San Borja. El estudio : Estudio analítico, retrospectivo. Se evaluó pacientes atendidos en el INSNSB, durante los períodos de marzo a diciembre 2019 y 2020. Se obtuvieron datos de las historias clínicas. Para la estadística se empleó el programa SPSS v25 (IC 95%). Hallazgos : Se analizaron 139 pacientes en cada periodo. El 60.4% y el 76.3% procedía de Lima, antes y durante la pandemia respectivamente. El grado de instrucción más frecuente del familiar responsable fue el de secundaria (42.3% y 58.2%). Además, las quemaduras menores mostraron un aumento antes y durante la pandemia (49.9% y 61%). Conclusiones: Se observó cambios significativos en la procedencia, grado de instrucción del familiar responsable y severidad de quemadura en ambos períodos

Objective: To compare the clinical-epidemiological characteristics of patients with burns before and during the COVID-19 pandemic treated at the "Instituto Nacional de Salud del Niño San Borja" . The study: Analytical, retrospective study. Patients treated at the INSNSB, during the periods from March to December 2019 and 2020. Data were collected from medical records. For statistical, the SPSS v25 program (95% CI) was used. Findings: 139 patients were analyzed in each period. 60.4% and 76.3% of patients came from Lima, before and during the pandemic, respectively; The most frequent level of education of the responsible family member was high school (42.3% and 58.2%). Also, minor burns showed an increase before and during the pandemic (49.9% and 61%). Conclusions: Significant changes were observed in the origin, degree of the responsible family member and the severity of burn between both periods.

Effect of improving cleaning and disinfection methods on the prevention,control and disinfection of CRE in burn plastic surgery ward / 中国感染控制杂志

Objective To explore the effect of improving cleaning and disinfection methods on the prevention,con-trol and disinfection of carbapenem-resistant Enterobacterales(CRE)in burn plastic surgery ward.Methods 297 patients who admitted to the department of burn plastic surgery in a hospital from February 1 to August 31,2021 were selected as the control group,and 210 patients who admitted to the hospital from September 1,2021 to Febru-ary 28,2022 after cleaning and disinfection methods improved were selected as the intervention group.Detection rate of CRE from patients,incidence of healthcare-associated infection(HAI)with CRE,and detection rate of envi-ronmental CRE before and after intervention were statistically analyzed and compared.Results The incidence of HAI and detection rate of CRE from patients in the intervention group were 0.95％and 0,respectively,lower than 4.04％and 2.02％in the control group(both P＜0.05).Compared to the control group,qualified rates of detec-tion of air and surface microbiology,adenosine triphosphate(ATP)bioflorescence and fluorescence labeling in the intervention group were all higher(x2=5.52,13.08,6.66,and 15.01,respectively,all P＜0.05).Conclusion Improving cleaning and disinfection method can reduce the incidence of HAI and the detection rate of CRE in burn wards,improve the surface cleanliness of environmental objects,as well as the effectiveness of HAI prevention and control.

Clinical observation of amniotic membrane transplantation combined with entropion correction for ocular surface and eyelid burns / 局解手术学杂志

Objective To explore the clinical effect of amniotic membrane transplantation combined with entropion correction for ocular surface and eyelid burns.Methods A total of 80 patients with ocular surface injury and lower eyelid entropion caused by chemical or thermal burns who received surgical treatment in our hospital were selected as the research objects.All patients received amniotic membrane transplantation combined with entropion correction.All patients were examined by slit-lamp microscope and photographed before and 8 weeks after surgery.The visual acuity changes,tear film rupture time and serum levels of vascular endothelial growth factor(VEGF),trans-forming growth factor β1(TGF-β1)and insulin growth factor 1(IGF-1)were compared before and 8 weeks after surgery.Eight weeks after surgery,exfoliated epithelial cells of the central cornea and limbus were collected and analyzed by PAS staining and immunofluorescence staining.Results At 8 weeks after surgery,the patient's ocular surface condition recovered well,eyelid entropion was successfully corrected,postoperative visual acuity was significantly better than that before surgery(P<0.05).Compared with before surgery,the tear film rupture time 8 weeks after surgery was significantly prolonged(P<0.05),and the serum VEGF,TGF-β1 and IGF-1 levels 8 weeks after surgery were significantly increased(P<0.05).PAS staining showed that there was no goblet cell in the central cornea and limbus.Immunofluorescence staining showed that cytokeratin 12(CK12)was highly expressed in the corneal epithelial cells,and low expressed in corneal limbal epithelial cells near the cornea.Conclusion Amniotic membrane transplantation combined with entropion correction has a significant therapeutic effect on patients with ocular burn,which can promote ocular surface repair,correct entropion,improve postoperative visual acuity,and achieve self-amplification of cornea stem cells.It is a safe and effective treatment method.

Clinical effect of free medial plantar flap on reconstruction of severe thumb defect caused by electric burn / 中华显微外科杂志

Objective:To explore the technique and clinical effects of free medial plantar flap on reconstruction of the severe defect of thumb caused by electric burn.Methods:Surgical techniques and clinical effects were explored in reconstruction with free medial plantar flap for treatment of severe electric burns of thumbs. From July 2016 to July 2021, 18 patients suffered from severe electric burns of thumbs were admitted in the Department of Burn, Zhengzhou First People's Hospital. All the wounds were the entrance of electric burns. After thorough debridement, the arteries, nerves, tendons, phalanges and interphalangeal joints were exposed to various degrees. Damaged digital proper palmar arteries were ligated and defected proper palmar digital nerves were marked and further anastomosed with the nerves carried by the flap. Palmaris longus tendon grafts were employed to reconstruct the defects of flexor pollicis longus tendon. Wounds were closed by transfer of free medial plantar flaps, and the flap donor sites were closed by inguinal skin grafts. Survival of the flap was observed 1 week after surgery, and the survival of the skin graft in the foot donor site 12 days after surgery. Outpatient follow-up including observation of the appearance and texture of the flap, evaluation of sensory function, thumb alignment and finger flexion according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. Evaluate the scar hyperplasia in the foot donor site and the standing and walking functions of the donor foot.Results:All flaps survived,at 1 week after surgery. On the 12th day after surgery, all 16 foot flap survived, and 2 patients had local necrosis, and the necrosis healed completely after dressing change for 10 days, the wound healed completely. Among them, 3 patients without tendon transfer experienced a rupture of the flexor pollicis longus tendon at 2 months after surgery, and underwent another palmaris longus tendon transfer. After the surgery, functional exercise was performed with the palm and flexor fingers. After 6-12 months of follow-up, the blood supply, appearance, and texture of the flap were good and similar to that of the palmar skin of the thumb, with varying degrees of recovery in sensation. The TPD was 6-11 mm, and the thumb was restored to varying degrees. According to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 13 cases in excellent and 5 cases in good. Mild scar hyperplasia remains in the flap site of donor feet, which does not affect the standing and walking functions of the donor foot.Conclusion:The texture of medial plantar skin is similar to that of palmar skin, with good wear resistance and good sensation. Furthermore, it causes a little damage to the donor site and without obvious complication. The medial plantar flap is ideal for reconstruction of a severe wound caused by electric burn in thumb.

Prognosis factors for extremely severe burn patients combined with sepsis / 中华急诊医学杂志

Objective:To explore forecast indicators for the prognosis of sepsis in adult extremely severe burn patients.Methods:Case data of adults with extremely severe burns combined with sepsis admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to December 2021 were retrospectively collected. According to the prognosis, all patients were divided into a death group and a survival group. The general conditions of the two groups were compared. The clinical symptoms, vital signs, platelet count (PLT), white blood cell count (WBC), neutrophil ratio, procalcitonin (PCT), blood sodium, blood glucose, hemoglobin and albumin levels at diagnosis of sepsis were also compared between the two groups. The independent sample t test, Mann?Whitney U test, or Fisher's exact probability test was used for group comparison. Variables with statistical significance in univariate analysis were included in the Cox regression model for multivariate analysis to assess the effect of each index on the outcome of extremely severe burn patients with sepsis. The predictive value of each index for sepsis outcome was analyzed by the receiver operating characteristic curve (ROC). Results:A total of 60 patients with particularly severe burn sepsis were selected, including 41 males and 19 females aged 18 to 84 years. The diagnosis time of sepsis was 14 (7, 24) days after injury. There were 29 patients in the death group and 31 patients in the survival group, and the mortality rate was 48.3%. Compared with the survival group, PLT and hemoglobin levels in the death group decreased significantly (both P<0.05), and PCT and blood sodium levels increased significantly (both P<0.05), while the other indicators did not change significantly (all P>0.05). The results of multivariate Cox regression analysis showed that hemoglobin ( HR=0.936, 95% CI: 0.935-0.991) and serum sodium levels ( HR=1.031, 95% CI: 1.010-1.052) at the time of sepsis diagnosis were independent risk factors affecting the prognosis of sepsis in extra-severe burn patients (both P<0.05). ROC curve analysis showed that the AUCs of hemoglobin, blood sodium and PCT for predicting the prognosis of extremely severe burn patients with sepsis were 0.747, 0.811 and 0.690, respectively (all P<0.05). The cut-off value of hemoglobin for predicting prognosis was 77 g/L, with a sensitivity of 69.0% and specificity of 74.2%. The cut-off value of blood sodium for predicting prognosis was 138 mmol/L, with a sensitivity of 89.7% and specificity of 61.3%. The cut-off value of PCT was 3.51 μg/L, with a sensitivity of 65.5% and specificity of 74.2%. Conclusions:Hemoglobin, blood sodium and PCT may be predictors of outcome in extremely severe burn patients with sepsis.

Antibacterial and Wound Healing Activity of 2% Formulation of 2-Medpy-3-CN on Infected Burn Wounded Animal Model

@#Introduction: Humans have learned to recognize and process plants into medicinal forms through centuries. Burns can spread to other tissues, especially when infected with bacteria such as Methicillin-Resistant Staphylococcus aureus (MRSA). The study aimed to assess the in vivo antibacterial and wound healing activity of 2% formulation of 2-Medpy-3-CN on infected burn wounded animal model. Methods: In vitro antibacterial activity of the Alsti was done by broth dilution and disc diffusion methods. Alsti 2% ointment was prepared for the infected burn wound treatment. A total of 18 rats are grouped into A, B, C, and D, the first three groups (A-C) were injured thermally, and Group D was used as healthy controls. The three test Groups were exposed to MRSA ATCC 43300 at 105 CFU/mL. Group A was treated with 2% Alsti, Group B with Silver sulfadiazine 1% (SSD), and Group C was untreated. Wounds healing was assessed by the healed area and microscopic identification of hematoxylin and eosin (H&E)-stained skin tissue. Results: Wound healing progresses with application of Alsti 2% ointment as observed through wound diameter and histopathological changes of the skin. Wound diameter decreases with treatments, while the contrary was observed in the non-treated group. Microscopic observation of the stained skin showed that epidermal development, and collagen formation progress with treatment days. Untreated wounds showed marked inflammation, progressive ulceration, and necrosis. Conclusion: Alsti 2% formulation showed antibacterial and wound healing activities, hence, can be used as alternative in burn wound infections.

Inhibitory effect of miR-497 on corneal neovascularization and its regulation mechanism targeting STAT3 / 中华实验眼科杂志

Objective:To investigate the role of microRNA (miR)-497 in the formation of corneal neovascularization (CNV) induced by alkali burn and its mechanism.Methods:Forty-two wild type (WT) C57BL/6 mice aged 6 to 8 weeks, 42 CRISPR/Cas9 mediated miR-497 knockout (KO) and 42 CRISPR/Cas9 mediated overexpression transgenic (TG) C57BL/6 mice were selected and assigned as WT group, KO group and TG group, respectively.The corneal alkali burn model was established.At 3, 7, 14 and 21 days after modeling, corneal epithelium damage and stromal turbidity were scored according to slit lamp microscopy.The area of neovascularization was measured.Corneal structural changes and expression of inflammatory cells were observed by histopathological staining.The expression of CD31 in corneal tissues was detected by immunohistochemistry staining.The targeted binding relationship between miR-497 and signal transducer and activator of transcription 3 (STAT3) was detected by luciferase reporter assay.The relative expressions of miR-497, vascular endothelial growth factor A (VEGFA), tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-1β and macrophage inflammatory protein (MCP)-1 mRNA were detected by real-time quantitative PCR.At 14 days following modeling, the expression of STAT3 and p-STAT3 proteins in mice corneal tissues was detected by Western blot.The use and care of animals complied with the ARVO statement.The study protocol was approved by the Ethics Committee of Renmin Hospital of Wuhan University (No.2019K-K010).Results:Corneal injury, inflammatory cell infiltration and CNV occurred in mice cornea after alkali burn.Corneal epithelial injury score, corneal stromal turbidity score and CNV area increased first and reached the peak on the 14th day after modeling, and then decreased.There were significant differences in corneal epithelial injury score, corneal stromal turbidity score, CNV area and number of CD31-positive cells among various time points after alkali burn ( Fgroup=49.19, 34.56, 44.56, 77.56; all at P<0.01; Ftime=51.62, 65.62, 71.32, 46.12; all at P<0.01). Corneal epithelial injury score, corneal stromal turbidity score, CNV area and the number of CD31-positive cells were greater in KO group at various time points than in WT and TG groups, and those in WT group were greater than in TG group (all at P<0.05). In WT STAT3 co-transfected cells, the luciferase activity of the miR-497 group was significantly lower than that of the miR-negative control group and normal control group (both at P<0.05). In mutant STAT3-transfected cells, there was no significant difference in luciferase activity among all groups ( F=0.69, P=0.56). On the 14th day after modeling, the relative expression levels of miR-497 in corneal tissue of WT, KO and TG groups were 0.68±0.11, 0.41±0.06 and 1.05±0.14, respectively, which were significantly lower than 1.00±0.04, 0.56±0.07 and 1.34±0.11 before modeling (all at P<0.01). The relative expressions of STAT3 and p-STAT3 were higher in KO group than in WT and TG groups, and were lower in TG group than in WT group, and the differences were statistically significant (all at P<0.05). The expressions of VEGFA, TNF-α, IL-6, IL-1β and MCP-1 mRNA at various time points after modeling in various groups were significantly higher than before modeling, which were higher in KO group than in WT and TG groups and were lower in TG group than in WT group, and the differences were statistically significant (all at P<0.01). Conclusions:MiR-497 inhibits corneal inflammation and CNV formation induced by alkali burn.It might inhibit the activation of the inflammation signal pathway via targeting STAT3.

"Proximal to distal" sequence of the release of the upper extremity post-burn contracture: Rule or case-based approach? / 中华创伤杂志(英文版)

Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.

Repair effects and mechanism of Zhixu burn ointment on deep second-degree burned model rats / 中国药房

OBJECTIVE To study the repair effect and mechanism of Zhixu burn ointment on deep second-degree burned model rats. METHODS The deep second-degree burned model was established with a temperature-controlled apparatus. The model rats were randomly divided into model group， Jingwanhong ointment group and Zhixu burn ointment high-dose， medium-dose and low-dose groups （specifications were 20 g core+20 mL wetting agent， 10 g core+20 mL wetting agent， 5 g core+20 mL wetting agent， respectively）. Another blank control group （only dehairing treatment， no modeling） was set up， with 10 rats in each group. The rats in each administration group were given corresponding drugs， the rats in the blank control group were not treated， and the rats in the model group were given normal saline once a day for 21 d. The healing of burn wounds and histomorphological changes of burned skin in each group of rats were observed， and the healing rate of wounds was calculated； the levels of vascular endothelial growth factor （VEGF）， interleukin-1β （IL-1β）， IL-6 and tumor necrosis factor-α（TNF-α） in the wound skin tissue of rats were detected by enzyme-linked immunosorbent assay； immunohistochemical method was used to detect the expression levels of VEGF and platelet endothelial cell adhesion molecule-1 （CD31） protein in burned skin tissue. RESULTS Compared with model group， the wound area of the rats in the Jingwanhong ointment and Zhixu burn ointment groups gradually decreased and healed significantly by day 21， and the wound healing rate was significantly higher （P＜0.05 or P＜0.01）； thicker new epidermal layer was seen in the skin tissue， and connective tissue and new blood vessels were significantly increased in the dermis； the expression levels of IL-1β， IL-6 and TNF-α were significantly decreased （P＜0.05 or P＜0.01）， and the expression levels of VEGF and CD31 protein were significantly increased （P＜0.05 or P＜0.01） in the burned skin tissue. CONCLUSIONS Zhixu burn ointment can repair the skin of deep second-degree burned model rats， and the mechanism may be related to reducing the inflammatory response of burn wound and promoting the angiogenesis.